Healthcare Provider Details

I. General information

NPI: 1801424254
Provider Name (Legal Business Name): TESSA HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3395
US

IV. Provider business mailing address

240 SUMMERGLOW RD
RUSSELLVILLE AR
72802-1758
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax:
Mailing address:
  • Phone: 501-722-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-19478
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: